Presentation
A 27-year-old man, in good health until then, consulted for an erythematous and itchy rash on the limbs which occurs regularly but in very specific circumstances: only after football training.
It all started at the age of 9, during a football match. Since then, this phenomenon has been repeated after any intense physical activity – particularly football – which unfortunately prompted him to gradually limit his sporting practice.
Examination
At the age of 23, the lesions evolved:
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appearance of generalized urticaria 15 to 20 minutes after the start of exercise.
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skin lesions that disappear spontaneously within two hours, without medical intervention.
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absence of respiratory symptoms (dyspnea, edema of the lips or tongue, pharyngeal discomfort) or angioneurotic edema.
When asked about possible triggering factors, he did not report any food, medication or substance ingested before the episodes started. He reports no known allergies and his medical history is limited to wisdom tooth extraction. He also claims not to consume alcohol, tobacco or recreational drugs.
During acute episodes, he describes a sensation of heat accompanied by redness in the face, without other associated systemic manifestations (dyspnea, chest pain or edema of the mucous membranes). However, over the past three months, the frequency and intensity of the episodes had increased, which prompted him to seek help.
Clinical examination and evaluation
During the initial clinical examination, carried out outside of an acute episode, the patient is in good general condition, with no signs of discomfort or apparent distress. The skin is healthy, with no rash or lesions visible, and the examination of the mucous membranes is unremarkable. Examination of the upper and lower limbs reveals no abnormalities (notably no edema), and the peripheral pulses are symmetrical and well felt. Cardiac auscultation found normal sounds, without associated murmurs, and pulmonary auscultation was unremarkable, as was the abdominal examination.
The cervical, axillary and inguinal lymph node areas are free.
The neurological examination also found no abnormality: muscular strength 5/5 in all limbs, normal and symmetrical reflexes, preserved sensitivity. The ENT examination is also unremarkable.
Biological analyzes have already been carried out: the CBC does not contain any abnormalities (leukocytes 7,500/mm³ with a leukocyte formula within normal limits). Total immunoglobulin E (IgE) levels are slightly increased (110 IU/mL). The liver and kidney functional assessments are, for their part, completely normal.
On the imaging side, a chest x-ray shows no abnormality. A transthoracic echocardiogram is performed to rule out a cardiac cause for these symptoms induced by physical effort. This examination is normal, with no signs of cardiomyopathy or valvular dysfunction. Finally, spirometry concluded that lung volumes and capacities were normal, with no indication of bronchospasm.
